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PATHOPHYS Flashcards

1
Q

what test distinguishes acute coronary syndrome w/ classic MI?

A

EKG findings, MI will have ST elevation (STEMIs, w/ complete occlusion of the artery)

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2
Q

what happens after rupture of atherosclerotic plaque

A

vasocsontriction and platelet aggregation

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3
Q

which factors contribute to a vulnerable plaque?

A

low smooth muscle cell count
thin fibrin cap
large lipid core
high macrophage content

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4
Q

what does ST elevation usually mean

A

complete occlusion of coronary artery

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5
Q

what does a CXR look like on a pt who has had an MI and now has developed HF?

A

white fluffiness in the lungs (fluid in alveoli)
CHF–>pulm. edema
lungs sound like water boiling
abnormal accum. of salt and water in lungs

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6
Q

3 vessel coronary disease

A

LAD
circumflex
right coronary artery

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7
Q

what are the 2 major determinants of Oxygen demand

A

HR and SBP

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8
Q

what is used for bypass

A

L. internal thoracic artery (aka internal mammary a.) or leg veins

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9
Q

what if a STEMI is seen on EKG?

A

pt goes to cath lab

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10
Q

what does a ST elevation show?

A

100% blockage

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11
Q

which pts need bypass surgery?

A
  1. pts with >50% stenosis of left main coronary artery (before it splits into LAD and circumflex)
  2. pts with 3 vessel coronary disease
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12
Q

what are 2 main events in ACS?

A

coronary artery constricts

blood clots

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13
Q

what are the risk factors for endothelial dysfunction that cause ACS?

A

lipoproteins, smoking, cytokines, turbulent flow, ROS, AGEs, HTN

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14
Q

what is chronic stable angina?

A

pain w/ exertion, increase in demand without increase in supply

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15
Q

What is the most common cause of sudden cardiac death?

A

ventricular fibrillation

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16
Q

what is the most common cause of stroke?

A

atrial fibrillation

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17
Q

what is the best way to kill someone?

A

IV K+ (wide QRS, die in diastole)

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18
Q

how should someone who V. fib

A

w/ an AICD (defibrillator)

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19
Q

what can digoxin poisoning cause?

A

ventricular fibrillation

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20
Q

what does concentric ventricular hypertrophy predispose?

A

CAD

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21
Q

where is multifocal atrial tachycardia seen?

A

in COPD

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22
Q

the diagnosis of aortic stenosis can be made by what 3 things?

A
  1. hx and physical (triad of HF, angina, syncope)
  2. Echocardiography
  3. Cardiac Cath
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23
Q

what do you need to know about acute regurgitation?

A

no time to adapt, hypertrophy (loud murmur w/o hypertrophy)

lack of eccentric hypertrophy of atrium
high left atrial pressure during systole (increased V wave) pulmonary wedge pressure

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24
Q

What does aortic stenosis sound like?

A

clearing your throat (mid-systolic)

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25
what part of your hand do you use when you palpate for the PMI?
interphalangeal joints
26
estimate the size of the PMI?
about the size of a dime
27
how do they determine who gets surgical valve replacement for stenosis?
there is a high risk for operation and pt will likely be on warfarin for life-->if there is a triad of symptoms (HF, angina, syncope), quantify by ECH, gradient of cardiac cath
28
what is newman mean by gradient?
happens w/ aortic stenosis normally the pressure in left ventricle and aorta should be similar, but w/ stenosis the LV pressure is crazy high and aortic pressure is normal or low
29
3 things you need to know about mitral regurgitation
1. most common cause is MVP 2. rheumatic fever can cause 3. has eccentric hypertrophy-dilated L. ventricle and atrium
30
2 main things you need to know about bacterial endocarditis
1. "bugs in the blood" due to injury, iatrogenic (IV lines, caths, tubes in colon, IVDU are #1) 2. damage to valve-valvular disease
31
what are the facts you need to know about the complications of infective endocarditis?
1. emboli 2. damage to to the valve (could cause aortic regurg) Mitral: stroke is most feared complication Tricuspid valve -->pulmonary embolism
32
why is acute mitral regurgitation life threatening?
there isn't enough time for dilation of atria, so there is simply pulmonary edema
33
what is normal thickness of interventricular septum? and what is it in concentric hypertrophy?
1. 1 cm | 2. 3-4 cm
34
which valvular disorder will have a really high pulse pressure?
aortic regurgitation
35
what are the 3 things newman wants you to know about acute aortic regurgitation?
1. no hypertrophy or dilation 2. murmur but normal pulse 3. causes:infection dissection
36
what is the resting pot'l for pacemaker cell?
-65 mV
37
what is the resting pot'l for myocardial cell
about -90 mV
38
what are the 2 main diseases that alleviate pain when you lean forward?
1. acute pericarditis (pulling heart closer to chest wall, helps you hear it better too) 2. pancreatitis
39
what are the 3 neurohumoral systems in heart failure?
1. SNS 2. RAAS 3. ANP
40
4 drugs which improve survival?
ACEis beta-blockers spironolactone (others)
41
3 contraindications to heart transplant
1. severe pulm. HTN 2. over 65 yrs 3. drug addict/alcoholic/non-compliant pts
42
what are newman's symptoms for acute heart failure?
``` syncope nausea muscle cramps turn on RAAS (pseudohypovolemia) short of breath pulm. congestion cool extremities decreased urine output ```
43
what do you know about acute pericarditis?
syndrome of inflammation of pericardium most cases are idiopathic pericardium gets filled w/ wbcs/pus/rbc's pain is alleviated by leaning forward
44
what do you know about pericardial effusion?
descriptive term normally 50 mL w/ low protein content in pericardium cause: some things that can cause acute pericarditis (lung cancer) has large clear space (halo) arround the heart always pathologic (doesnt cause syndrome)
45
which condition has a characteristic halo surrounding the heart?
pericardial effusion
46
cardiac tamponade is essentially a problem with ______________
diastolic filling
47
what is the clinical hallmark of tamponade
pulsus paradoxus
48
what do you know about pulsus paradoxus?
clinical hallmark of tamponade when you inhale pulse goes away when exhale pulse comes back basically doesnt allow right ventricle to expand (causes bulging intervent. septum into left ventricle-->decrease in volume of the left ventricle)
49
if you have pulsus paradoxus what happens to your EDV when you inspire?
EDV decreases (think C-clamp picture)
50
what are the 2 main principal mechanisms of cardiac arrhythmias?
1. altered automaticity | 2. reentry
51
what does enhanced automaticity refer to?
basically means the cells are firing their action pot'ls before the proper time Phase 4 has been altered and risen to threshold pot'l at abnormal time
52
name some causes that increase automaticity
``` increased SNS increased catecholamines decreased parasymp.NS increased CO2 decreased O2 increased acidity increased temp. increased stretch digitalis decreased K+ increased Ca2+ ```
53
what are the conditions required for cardiac reentry?
1. noncontiguous pathway 2. unidirectional impulse blocked 3. slower conduction velocities
54
mnemonic for the cyanotic congenital heart defects
I: Truncus arteriosus II: transposition of the greater arteries (2 great vessels) III: tricuspid atresia IV: tetralogy of Fallot (tetra) V: total anomalous pulmonary venous return (5 words)
55
an unrestrictive _________ in a newborn infant is likely to be associated w/ little or no murmur
VSD
56
an unrestrictive VSD in a 2 month old infant w/ normal pulm. resistance is likely to be associated w/ a IV/VI systolic murmur at the _____________, and a II/VI diastolic rumble at the _____________-
1. mid left sternal border | 2. apex
57
the mechanism for the systolic murmur at teh left upper sternal border in a pt w/ an ASD is relative ____________________ from increased pulm. flow
pulmonary stenosis
58
Cyanosis may be related to central _______
apnea
59
cyanosis may be related to pneumonia or ______________
pneumothorax
60
cyanosis is ________________ related to intracardiac shunting
sometimes
61
cyanosis is present in _____________congenital heart defects
some
62
O2 delivery is determined by
CO x arterial O2 content
63
what is vO2 ?
O2 extraction (arterial venous difference, normal is about 25% that is extracted)
64
what happens to the vO2 parameter as CO decreases?
vO2 which is O2 extraction goes up
65
which pts are most likely to die in HF?
have decreased cardiac index mixed venous O2 decreased A-V O2 diff increased
66
what is cardiac index
cardiac output
67
what does the left ventricular filling pressure represent?
preload (increased preload will cause pulmonary edema) *best way to treat is with diuretics spironolactone
68
what does ACEi due to serum K+?
hyperkalemia
69
what is class I HF
low ejection fraction/asymptomatic
70
what is class II HF
some symptoms/shortness of breath
71
what is class III HF
can't walk across the room
72
what is class IV HF
can't even rest without dyspnea
73
what is the most common cause of CHF
transmural MI
74
what does the ejection fraction not tell us?
it doesn't tell us about RBF, CO, RAAS, salt and wter
75
what happens to your renin levels when you stand up?
renin levels go up
76
what percentage of CO is needed to maintain FF in the kidneys?
20%
77
how is hot weather hazardous to HF pts?
RAAS is turned up by heat
78
what happens when you bed rest a HF pt?
they get a smaller heart and alleviated HF symptoms
79
what is compensated HF?
ejection fraction 25%, taking meds, getting by, equal contribution of ANP and RAAS
80
what is decompensated HF?
lungs sounds like water, RAAS overtakes ANP, (urine Na/K ratio <1 aldo has overriden ANP)
81
JVD has an increased volume of ________ when apparent
3 L
82
anasarca= __________L of fluid, testicles size of basketballs, fluid int he belly
30L
83
newman describes pulmonary congestion as what
can't lie flat at night
84
4 drugs that save lives
ACEis beta blockers (carvedilol) spironolactone ARBs
85
how do you get a better response to loop diuretics?
bed rest
86
why is spironolactone good at reducing sudden cardiac death?
is is K+ sparing, and hypokalemia is linked to arrhythmias
87
what does the pulmonary artery catheter measure?
LV filling pressure
88
term for salt-avid state with Na+ and water retention
CHF

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